Surgical techniques and outcomes of robot-assisted anatomical lung resection in patients with complete pleural adhesions

Robot-assisted thoracoscopic surgery is challenging in cases with complete pleural adhesions. To date, no previous reports have addressed this issue. We evaluated the surgical outcomes of robot-assisted anatomical lung resection in patients with complete pleural adhesions.

Among 810 patients who underwent robot-assisted anatomical lung resection at our institute between 2017 and 2024, we retrospectively investigated 24 (3.0%) that presented with complete pleural adhesions. Complete pleural adhesion was defined as attachment of the entire parietal and visceral pleura.

Patient median age was 73 years. Six patients (25%) had a history of ipsilateral thoracic surgery and four (17%) had a history of ipsilateral thoracic disease. Eighteen patients (75%) underwent a lobectomy and 6 (25%) underwent a segmentectomy. Mediastinal lymphadenectomy was performed in 14 patients (58%). Complete adhesiolysis within the thoracic cavity was achieved in 20 (83%) patients. No cases required conversion to open thoracotomy. Median operative and console times were 276 min and 228 min, respectively. Median intraoperative blood loss was 10 mL. No cases required blood transfusions. Postoperative grade 3 complications were observed in eight patients, including prolonged air leak in seven patients and chylothorax in one patient. The 90-day mortality rate was 0%.

Robot-assisted anatomical lung resection in patients with complete pleural adhesions yielded acceptable perioperative outcomes without conversion to open thoracotomy. Our robot-assisted procedure is useful in cases with complete pleural adhesions, including dissection of the diaphragmatic plane.